Rehabilitation after a stroke will depend on numerous factors, including the type of stroke you had, severity of stroke symptoms, how much brain tissue was injured, and which functions—like walking, speech, and swallowing—may be involved, according to Christopher Yi, M.D., a vascular surgeon at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. But no matter how you or someone you love has been affected by stroke, professionally led exercises are often recommended as a way to regain what’s been lost.
We asked stroke experts to share the benefits of exercise, plus the specific moves that physical or occupational therapists often prescribe to help people become more mobile after a stroke.
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Why Exercise Supports Stroke Recovery
In general, the first one to three months are particularly important for stroke rehabilitation because this is when the most significant neurological recovery occurs, says Dr. Yi.
“Treatment may include physical therapy for walking and strength, occupational therapy for activities of daily living and use of the arm and hand, and speech therapy for communication or swallowing problems,” he adds. “Repetition is extremely important because rehabilitation helps the brain reorganize and develop new pathways to compensate for areas damaged by the stroke.”
In terms of a stroke recovery timeline, however, there is no standard order of which functions recover first, because it depends on the part of the brain that was injured by a stroke, he adds. In stroke survivors with muscle weakness, larger movements of the leg or arm may sometimes improve before the fine motor control required for tasks such as writing or buttoning a shirt. Basic abilities such as sitting, transferring, standing, walking, eating, and dressing are often early priorities in rehabilitation. Speech, fine motor skills, complex cognitive tasks, and coordination can sometimes require a longer period of rehabilitation.
All of this combines to help those who’ve had a stroke regain function in a way that maximizes recovery and promotes independence, Dr. Yi says.
Exercises for Weakness After a Stroke
Muscle weakness is common after a stroke and it can make everyday functions very challenging, says physical therapist Thomas Verticchio, the senior manager of rehabilitation services at Northwell Health Staten Island University Hospital in New York. Here are two exercises he recommends.
Bridging Exercise
How to do it: Lying on your back with knees bent and feet flat on the bed or floor, push through your feet to lift your hips off the surface, creating a straight line from your shoulders to your knees. Hold briefly, then slowly lower. Do this exercise 5 times.
How it helps: This move is essential for trunk control, balance, and strengthening muscles that support your ability to transfer (such as from bed to chair). It also improves hip extension, a critical component of walking, and makes it easier to roll in bed and get dressed.
Sit-to-Stand Transfers
How to do it: Start in a seated position on a firm chair. Lean forward, push through your legs (especially the affected one if possible), and stand. Try not to use armrests for support. Reverse the motion to sit back down slowly and with control. You may need another person to assist initially as you practice this move. Do 5 times.
How it helps: Sitting to standing is one of the most fundamental tasks for daily living, from getting out of bed to getting off the toilet or out of a chair. The move strengthens your legs and core and improves balance while encouraging weight-bearing through the affected leg, which can help with spasticity management and bone density.
Balance Exercises for Stroke Patients
Because a stroke can often affect one side of the body, balance can be difficult, but Verticchio says there are exercises to retrain the body to achieve better balance. Here are two to consider.
Step-Ups
How to do it: Facing a low step (2–4 inches high), step up with the affected leg, bringing the sound leg to meet it on the step. Then step down, leading with the affected leg. Use handrails or a wall for support as needed. Do 5 times.
How it helps: This move strengthens leg muscles and improves balance and coordination. It directly prepares you for climbing stairs, navigating curbs, and overcoming obstacles encountered during walking.
Standing Weight Shifting
How to do it: Stand facing the kitchen counter with feet wide apart. Slowly shift your weight from one foot to the other, or forward and backward, keeping your hands on the counter for balance support. Do 10 shifts in each direction.
How it helps: This move teaches the brain to adjust to changes in body position and maintain equilibrium while also helping you relearn where your body is in space. It is an essential prerequisite for walking, as walking involves constant weight shifts, and reduces fear of falling by practicing controlled instability.
Seated Exercises After a Stroke
Having seated exercises in a recovery mix is important for conserving energy, and also for those who are working on gradually regaining their walking and balance. These two seated exercise options can be done anywhere.
Supported Reaching
How to do it: Sitting at a table, place your affected arm on the table. Using your stronger arm for assistance, slide the affected arm forward, backward, and side-to-side, reaching for objects. As control improves, lift the arm slightly off the table. Do several times until you are tired.
How it helps: This move trains the arm and hand affected by stroke to regain function and improves range of motion. It also enhances motor control and coordination and is directly related to tasks like eating, dressing, grooming, and reaching for objects.
Heel Slides
How to do it: For the heel slide, start by lying on your back, legs straight. Pull one heel towards your buttocks, bending your knee and sliding your foot along the surface. Slowly slide it back down. Switch sides. Repeat 5 times on each side.
How it helps: This move helps strengthen hamstrings and improves ankle mobility and strength, which is vital for walking.
Mobility Aids for Exercise and Daily Movement
Using a mobility aid can give you the confidence you need to stay active as you regain physical strength and balance after a stroke, especially as you transfer from an inpatient facility to at-home post-stroke care. It’s common for physical and occupational therapists to recommend a mobility aid for more stability and mobility, Verticchio says, so do not see the recommendation as a sign that you are not doing well; rather, it’s an indication your therapist thinks you can move even more. There are several types of mobility support that may be suggested:
- Canes. These improve balance, provide a point of contact for stability, and offer light support for weight-bearing.
- Walkers or rollators. A rollator offers a wide base of support for balance, while a walker provides substantial weight-bearing assistance.
- Ankle-foot orthoses (AFOs). These are braces that fit around the ankle and foot, extending up the calf. They primarily address “foot drop” (weakness in the muscles that lift the front of the foot) by holding the foot in a functional position during walking.
- Wheelchairs or power chairs. Manual wheelchairs provide independent mobility for individuals who cannot ambulate safely or efficiently but still have arm strength, while power chairs allow you to get around with the use of battery power.
- Crutches. These are less common for stroke but may be used when there is significant weight-bearing limitation on one leg while maintaining upper body strength and good balance.
How Therapists Help With Mobility Aids
A physical therapist plays a significant role in selecting and teaching the use of mobility aids, according to Verticchio. “In essence, the physical therapist acts as a guide, assessing individual needs, prescribing the right tool for the job, and providing the essential training to ensure the patient can use it safely, effectively, and with maximum independence,” he says. A physical therapist may help with:
- Comprehensive assessment. Before choosing a mobility device, a therapist may look at several factors, including physical status such as muscle strength and coordination as well as cognitive abilities including how you perceive your environment. An assessment will also look at your living situation to determine if there are any hazards that could affect the choice of mobility aid.
- Matching the right aid. Based on the comprehensive assessment, the physical therapist determines which aid (or combination of aids, like an AFO with a cane) provides the optimal balance of support, stability, and freedom for your current functional level.
- Proper fit and adjustment. The physical therapist ensures the chosen aid is properly sized and adjusted to your height and arm length. Incorrect fit can lead to improper posture, increased energy expenditure, and a higher risk of falls or injury.
- Training and instruction. Your therapist will teach you the correct way to move with the aid, ensuring safety and efficiency. This includes proper weight transfer. They also teach how to navigate various surfaces, doorways, small spaces, stairs, curbs, and how to safely get up from the floor if a fall occurs.
As your strength, balance, and coordination improve, the physical therapist will guide you in progressing to a less supportive device (such as from a walker to a cane). Conversely, if function declines, they can adapt the aid or recommend a more supportive one.
When to Stop Exercising
In the short term, exercises should be discontinued if there’s pain or worsening mobility, and it’s important to discuss this with a physical or occupational therapist, says Verticchio. However, keep in mind that this type of therapy does involve some level of discomfort, particularly when therapy is intensive.
In terms of when to stop exercising for stroke recovery, there actually isn’t an endpoint. Many of the exercises that are guided and recommended by a physical or occupational therapist can be continued at home. In fact, a stroke survivor can often use these exercises for years after a stroke to continue making progress, according to Dr. Yi.
“We used to place more emphasis on a relatively narrow recovery window, but we now recognize that the brain retains the ability to adapt and reorganize for months and even years after a stroke,” he says. “Continued exercise, rehabilitation, and practicing affected skills can still produce meaningful improvements.”
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